Huge ABC in an Infant- Drainage First?

Aneurysmal bone cysts (ABCs) are a rare benign tumor most commonly occurring in the 2nd decade of life.

We present an unusual case of huge ABC of the ischium in an infant presenting with urinary retention, constipation, right hip edema and weakness. Imaging with CT and MRI revealed the classic finding of ABC and significant mass effect, obstructing the bladder and the rectum, DVT of the right iliac vein and sciatic nerve compression with denervation muscle atrophy.

Initial management included an unconventional approach - ultrasound guided percutaneous drainage of the larger cystic spaces. Following the procedure, the patient was subsequently able to lay on her abdomen, had a spontaneous bowel movement, and leg swelling was reduced. Definitive surgical treatment by a multidisciplinary team is planned.

This case highlights the importance of multi-modality, hands on techniques and team work in a rare and complicated case.